7th International Meeting on Metabotropic Glutamate Receptors

Registration Form:


Family Name:	First Name:
Institute/Company:
Mailing address:
City:	Zip Code:	Country:
Phone:	Fax:
E-Mail:

Accompanying person/s:

Family name:

First Name:

Please check the box (vat not included)

Participants	€ 1000,00
Accompanying person	€ 500,00
Students *	€ 500,00
S.I. F Member	€ 500,00
* verification of student status required

Hotel Accommodation Form

Please reserve n°

Hotel (Please check the box)	stars	Double room single use	Double room
Hotel Capotaormina (NOT AVAILABLE)	4 stars	€ 180,00	€ 210,00
Hotel Panoramic (NOT AVAILABLE)	4 stars	€ 195,00	€ 195,00
Hotel La Plage (NOT AVAILABLE)	4 stars	€ 165,00	€ 195,00
Hotel Isolabella (NOT AVAILABLE)	3 stars	€ 110,00	€ 135,00
Hotel Baia delle Sirene (NOT AVAILABLE)	3 stars	€ 100,00	€ 120,00

*Prices per day, per room, including breakfast

Arrival date:	October 2011	Departure date:	October 2011
	Total n. of nights:	I will share accomodation with:

Important notes:
- If the hotel selected is not avaiable, the room will be reserved in another hotel.
- The reservation accompanied by remittance of the deposit for one night's stay in the hotel chosen
will be accepted, plus 20,00 per room for reservation expenses.
- The settlement must be paid to the hotel. An invoice or receipt for the entire amount will be given.

Modalities of payment:

By credit card:	Visa	Mastercard	Carta SI
CREDIT CARD NUMBER:
CARD HOLDER:
EXPIRE DATE:	CV2:

Please note that payment made by credit card will be added an additional 4% bank fee

By bank transfer free of any bank charges in favour of meglu:

Monte dei Paschi di Siena - Taormina Agency - Italy
Account .No. 000000224950 ABI Code 82590 CAB Code 01030 CIN J
IBAN IT18J0103082590000000224950 - SWIFT/BIC: PASCITMMCAT

Please send a copy of the bank transfer to: centrocongressi@tao.it or +39 0942 24251

SUMMARY

Registration:	€
Accompanying Person:	€
Hotel room deposit:	€
Agency fee per room:	€ 20.00
Total amount due:	€

DATA FOR INVOICE (FOR ITALIAN PARTICIPANTS)
All Prices are net of VAT 20% - VAT Charges will apply
Please note, that in case of credit card payment the invoice has to be issued to the cardholder.
For example: you CANNOT use your personal credit card if you want the invoice to be issued to your institution or vice versa

Name and Surname:

Institution:

Address:

VAT no. (in case of billing to institutions):

Fiscal Code (in case of billing to physical persons):

Privacy - Italian Law n. 196/2003
In compilance with above mentioned law, Centro Organizzazione Congressi declare that all personal data collected in the attached form will be handled confidentially and only for communication or accountability purposes.